MISS DIAGNOSIS
From mental illness to heart attacks, women have suffered in silence as doctors ignore their symptoms. Finally, medical research is paying attention
S OMETHING surprising happened when Edna Haber went to the doctor a few years ago, complaining of dizzy spells and feeling like something was “off.” After a barrage of tests, her charts came back clean, so she was prepared to be dismissed and told nothing was wrong with her.
Instead, Haber, a healthy and vibrant 80year-old, says the strangest thing happened. “My doctor said, ‘I believe you.’ ”
Haber’s cardiologist, Nieca Goldberg, MD, sent Haber home on a Friday with a heart monitoring device to wear over the weekend that would send readouts back to her medical team.
“I got a call Sunday night asking what I was doing, but I was just watching TV,” says Haber, a retired mortgage broker living in Westchester. “My report showed flatlining. My heart was stopping.”
By Monday, she was having a pacemaker implanted.
For decades, the medical field has dismissed female health concerns. Women have been told that they’re imagining symptoms of heart attacks and other life-threatening ailments, and few resources have been devoted to researching their medical problems, but, at last, that seems to be changing.
“In 2018, half of the research participants in clinical trials for new drugs were women for the first time in our history,” says Amy Miller, Ph.D. and CEO of the Society for Women’s Health Research, a DC-based nonprofit founded in 1990. “We have gotten very close to parity.”
Just 30 years ago, women weren’t even allowed to be used as test subjects in most National Institutes of Health-funded clinical trials because researchers were afraid of a new treatment’s possible effects on a pregnancy — it took weeks to confirm back then — and because of the belief that the menstrual cycle makes females “too difficult” for scientific study.
“Women’s health has pretty much been ignored in biomedical pathology for our entire human history,” Miller says.
Goldberg, the medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Health, says that she often sees women who have had their concerns dismissed by another physician.
Heart problems in women can be tricky because the dramatic, sweaty, chest-grabbing “Hollywood heart attack” symptoms most of us associate with cardiac arrest are more common in men.
In women, the signs of a serious heart issue are often quite different and more subtle, such as experiencing shortness of breath, extreme fatigue or even pressure in the upper back.
“It’s portrayed as this middle-aged man’s disease,” says Goldberg, the author of “Dr. Nieca Goldberg’s Complete Guide to Women’s Health.” “For a long time, research was really lagging because they didn’t even think women could be at risk for heart disease.”
But, increasingly, doctors are taking women’s heart issues more seriously. Cardiovascular disease is the No. 1 killer of women in the US, according to the American Heart Association, accounting for one out of every three female deaths annually.
Last year, a study in the Journal of the American Heart Association found that women with a bigger waist-to-hip ratio were at greater risk of having a heart attack than
men with similar body shapes. The AHA is currently leading four new studies into women’s heart health.
Brain health is another area in which science is starting to play catch up. It was once thought that women were twice as likely to be diagnosed with Alzheimer’s disease because they lived longer. But at the Alzheimer’s Association International Conference held in LA in July, researchers identified a number of sexspecific differences in the progression and treatment of the disease. For instance, the toxic protein known as tau that’s associated with cognitive decline seems to spread more rapidly in female brains.
“A growing body of research shows us that Alzheimer’s disease differs between women and men,” says Miller, whose organization has called for studying the influence of estrogen and other hormones on brain function. This, Miller says, bodes well for more than Alzheimer’s research.
According to the Diagnostic and Statistical Manual of Mental Disorders, up until 1987, a doctor could label someone “schizophrenic” only if the onset occurred before age 45.
But numerous studies over the past two decades have found that there is a second peak of schizophrenia onset in women around ages 40 to 50. And because women experience a major drop in estrogen levels during those years, researchers now believe that estrogen may have an effect on psychosis in women, known now as the “estrogen hypothesis.”
Now, there is a spate of ongoing studies looking into this theory, as well as others that could improve women’s health. And the medical community is finally waking up to disparities at the doctor’s office, including how pain is managed.
“There’s growing evidence that when men go to an ER with pain, they are believed and treated,” says Miller. “Women are asked, ‘Does it really hurt?’ Women don’t want to admit to their doctor they have pain for fear of being told ‘it’s all in their head.’ ”
For Haber, having a doctor take her concerns seriously was vital.
“By simply listening and asking questions,” she says, “Dr. Goldberg saved my life.”